Establishment And Verification Of A Model For Postoperative Recurrence Of Hepatocellular Carcinoma

Objective:Hepatocellular carcinoma(HCC)is the most important primary liver cancer and is a common type of cancer in the world.Clinical outcomes of patients with hepatocellular carcinoma(HCC)are highly variable.This study aims to identify and validate a simple,readily available,and objective prognostic index for the management of HCC.Methods:Between March 1993and November 2010,3,516 patients newly diagnosed with liver cancer at the Afliated Hospital of Guilin Medical University(Guilin,People's Republic of China)were evaluated retrospec-tively.In the light of the included and excluded criteria,a total of 724 patients who underwent curative resection for HCC were eligible for this study.All 724 patients were randomly assigned to either a training cohort for developing a new prognostic index or a validation cohort for evaluating the obtained prognostic index at an approximately 2:1 ratio.Kaplan-Meier analysis was used to evaluate the progression-free survival(PFS)and overall survival(OS)of patients with hepatocellular carcinoma.Univariate analysis was performed to identify significant prognostic factors by using the Cox regression model.The multivariate Cox proportional hazards regression model was performed to identify independent predictors by including all the variables demonstrated to be significant in the univariate analyses.All statistical analyses were performed with SPSS18.0(SPSS Inc.Chicago,IL).Statistical signi cance was defined as P<0.05.To construct a best prognostic model,an exploratory formula was built by entering different sets of the independent factors into a regression model.The calculation formula for the novel prognostic model was as follows:N?LR=(neutro-phil count[10~9/L]×?-GT[U/L])/(lymphocyte count[10~9/L]U/L).Finally,the performance of the N?LR index was tested in the validation cohort.Results:1.Seven hundred and twenty-four HCC patients,with 463 in the training cohort and 261 in the validation cohort,were enrolled in this study.Overall,the clinicopathologic characteristics between these two cohorts were very similar,except for smoking.2.Compared with SII,ALRI and AFP,N?LR has more accurate prognostic value.3.An optimal cut-off value of 103.6 for N?LR stratified patients into high N?LR(>103.6)and low N?LR(?103.6)groups.N?LR>103.6 was closely associated with HCC malignant characteristics.Elevated N?LR predicted a worse overall survival(OS)and progression-free survival(PFS)for HCC patients and remained an independent predictor for both types of survival.Conclusions:N?LR was an important independent predictor of survival for HCC patients and might be a new promising method to identify patients at different risks of early recurrence and survival after curative resection.